Is starch digestion a point of interest in patients with exocrine pancreatic insufficiency?

Mößeler, Anne; Schwarzmaier, T.; Beyerbach, Martin; Kamphues, Josef

doi:10.1016/j.pan.2016.05.017

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“…These findings led to the assumption that starch digestion is not relevantly affected in EPI-patients and consequently dietary recommendations do not include any recommendations specifically regarding amylase substitution or limitation of starch. Nonetheless, some authors state that pancreatic enzyme replacement therapy (PERT) is recommended even when diet is low in fat but rich in starch [ 42 , 43 ]. Protein digestion is only moderately impaired in EPI-patients as well, taking into account the fecal digestibility.…”

Section: Background—digestive Processes In the Gastrointestinal Trmentioning

confidence: 99%

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Black‐Box Gastrointestinal Tract—Needs and Prospects of Gaining Insights of Fate of Fat, Protein, and Starch in Case of Exocrine Pancreatic Insufficiency by Using Fistulated Pigs

Mößeler

Kamphues

2017

Nutrients

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Exocrine pancreatic insufficiency (EPI) results in the maldigestion and malabsorption of nutrients. The digestive processes in humans and other monogastric species like rat and pig are characterized by a predominantly enzymatic digestion within the small intestine and microbial fermentation located in the hindgut. For protein, it is doctrine that only prececally absorbed amino acids can be transferred to the amino acid pool of the host, while postileal absorption of nitrogen-containing compounds occurs mainly in the form of ammonia, being a burden rather than a benefit for the organism. The pig is an established animal model for humans to study digestive processes. As digestion is markedly impaired in case of EPI the use of an appropriate animal model to study the effects of this disease and to optimize treatment and dietetic measures is of special interest. By using an animal model of experimentally-induced EPI allowing differentiating between digestive processes in the small as well as in the large intestine by use of ileo-cecal fistulated animals, marked effects of EPI on prececal digestion of starch and protein could be shown. The data indicate that estimation of digestibility of nutrients over the entire digestive tract results in a distinct overestimation of enzymatic digestion of starch and protein. Therefore, this model clearly shows that protein and starch digestion are significantly reduced in case of EPI although this cannot be detected on a fecal level. As postileal fermentation of starch is associated not only with energy losses but also with intensive gas production, this is of special interest to minimize meteorism and improve wellbeing of patients.

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Section: Background—digestive Processes In the Gastrointestinal Trmentioning

confidence: 99%

“…Furthermore, these results clearly show that treatment of EPI-patients should not only be focused on lipase supplementation. The use of multienzyme products containing amylolytic enzymes is recommended to optimize prececal digestibility of starch [ 43 ].…”

Section: Use Of Ileo-cecal Fistulated Pigs In Research On Diverse mentioning

confidence: 99%

Black‐Box Gastrointestinal Tract—Needs and Prospects of Gaining Insights of Fate of Fat, Protein, and Starch in Case of Exocrine Pancreatic Insufficiency by Using Fistulated Pigs

Mößeler

Kamphues

2017

Nutrients

Self Cite

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show abstract

Is starch digestion a point of interest in patients with exocrine pancreatic insufficiency?

Cited by 1 publication

References 0 publications

Black‐Box Gastrointestinal Tract—Needs and Prospects of Gaining Insights of Fate of Fat, Protein, and Starch in Case of Exocrine Pancreatic Insufficiency by Using Fistulated Pigs

Black‐Box Gastrointestinal Tract—Needs and Prospects of Gaining Insights of Fate of Fat, Protein, and Starch in Case of Exocrine Pancreatic Insufficiency by Using Fistulated Pigs

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